Dengue Fever

It is the familiar story line of a small David felling the giant Goliath to the ground; this time it is the small Dengue virus challenging the might of the government and bringing it down to its knees.
Dengue is having a free run this autumn, thanks to the rampant water logging and unrestricted breeding of mosquitoes.
Recognising Dengue Fever (DF): It is a viral infection transmitted by mosquitoes and presents as a sudden febrile illness of 2-7 days’ duration, with 2 or more of the following:
1. Headache
2. Pain behind the eye balls
3. Severe body aches
4. Pain in the joints
5. Rash
One of the main concerns in Dengue is the fall in platelet counts from its normal range of above 150,000. Platelets play a vital role in preventing or stopping bleeding from small blood vessels. Infusion of platelets is required only if they drop to below 20,000 or when there is active bleeding. Remember transfusions have their own risk of transmitting other infections, of allergic reactions, and their effect lasts barely a few hours.
The other concern is shock. Dengue sometimes causes fall in blood pressure due to leakage of plasma from capillaries with loss of blood volume. The Haemoglobin level paradoxically rises and urination may become less. Some patients show liver involvement (Serum ALT/AST, Bilirubin) or kidney dysfunction (increase in serum creatinine). These usually settle down with good intake of fluids and calories.
Tests for Fever: It is important to remember that all fevers may not be due to other infections such as Enteric Fever (Typhoid), malaria, and common flu that appropriate blood tests will show. It is important to get them done if fever persists for more than 2 days, because Dengue being a viral illness has no specific medicines, while typhoid and malaria have.
Tests should include Haemoglobin, PCV, white blood cell and platelet estimations, and tests for malaria, typhoid, and Dengue.
When to worry: If you have contracted Dengue, lie in bed and take rest for at least a week, drink lots of liquids (water, juices, soups, nimboo paani or ORS), take paracetamol tablets (up to 3 a day), avoid aspirin and ibuprofen as they may trigger bleeding, apply balms on your head and listen to soothing music. Consult your family physician but do not panic. Remember that there is no specific medication for Dengue and yet recovery is the rule.
Critical phase: Contrary to popular belief, the danger phase in dengue is not the 1st 2-3 days of high fever, but around the 5th to 7th day, when the fever begins to settle. Many people who are in a hurry to get back to their normal lives often crash during this phase with low BP and shock. It is therefore crucial to relax at home for a couple of days more.
And do what I am sure, the government is doing; tell yourself “This phase too shall pass”.

Eating Slow Can Help Slim Down

The slim and shapely figures of the overwhelming majority of natives I saw on the streets and trains of China during my visit to that country last week made me stand out amidst them with my Desi central bulge. And as this “ I-am –the-paunchy-one among-them” feeling is not something I feel while in Delhi, Punjab, or Gujarat, I tossed the question ‘What makes the Chinese remain slim?’
I had earlier put it to their genes. True most people with Mongolian traits (Chink eyed ones) like the Tibetans, Chinese, Koreans, Japanese look slim and short with smooth skins stretched over their bones and muscles. But catch them in USA after five years of devouring burgers and pizzas with bare hands, and notice the difference.
Or is it their diet? Most are rice eaters, but if rice was the secret to their shape, I couldn’t fathom why Bongs (Bengalis, a community to which I belong by genes and taste buds) queuing up for a table in front of “Oh Calcutta” get that paunch?
And if it is not rice, and if it is not WHAT they ate, what else could the Chinks have in common?
When my Chinese hosts took me to a traditional restaurant for dinner in Beijing, had me seated at the head of the table with a lavish spread of gourmet dishes, and then handed a pair of chopsticks, I realised I could not devour all that as quickly as I wished!
Fortunately I was not a total stranger to chopsticks, having had to use them as my survival tool during a long training trip in Japan many years ago. I remember that it had taken me a week to get the grip, grasp and movements tuned, and had started eating my full meal with just them, but at a very slow pace.
Old memories wafted in while I sipped the soup and watched how my hosts dealt with the dishes of boiled corn, pumpkins, egg, fish, chicken and even rice with just two thin sticks in between their fingers, nibbling at the food like restless ants.
What eating with chopsticks do is restrict the size of morsels. One can barely take a few grains of rice each time, unlike the large morsels that we Bongs scoop with bare hands and put in our mouths before gulping it down. And nibbling small amounts with chopsticks slows eating and stretches the meal time.
During eating, the food gets absorbed from the intestines and sends signals to the brain that then tells us to stop. If we eat slowly the signal reaches on time stopping us from consuming too much. When we eat quickly and gulp, we often miss the “Enough, Now stop” signal.
Eating slow can be a very effective way to slim down. And chopsticks ensure that you do just that. I have decided to take to chopsticks to get into shape.

India’s health : Then and Now

The country celebrated its 69th Independence Day last week. It is therefore a good time to look back on how India’s health has fared over this period. In numerical figures, we have covered some ground, but like the proverbial glass, optimists see it as half full, while pessimists view it as half empty.
The average Indian who expected to live till 32 years of age in 1950, is living twice as long now. Fewer children are dying in their first year of life (Infant mortality rate) and less mothers are dying of childbirth.
The national figures are however a mixed bag – some states and sections of society have done almost as well as developed countries, while some have lagged behind close to where we were half a century ago, dragging down our national figures.
The reduction and control of diseases mentioned above owe much of their success to several government initiatives as well as non-governmental organisations.
The major challenge of India is the dual fight of a ‘developing’ country’s basic health concerns such as malnutrition, low immunisation rates, hygiene, sanitation, and infectious disease while on one hand, while tackling environmental pollution and lifestyle choices such as alcohol consumption, smoking, and high fat diet are set to increase the incidence rates of heart diseases, strokes, diabetes and cancers, on the other.
Health and education are two sectors where results show up late. Unfortunately most governments have focussed on short term solutions like industrialisation, trade and defence, allocating less than 2% of spending on health (compare with 9 to 10% in developed countries).
While elections are decided by recent perceptions, we need leaders with far-sightedness to bring back the focus on health and education.
Here is a summary chart for those who like facts and figures;
1.Life Expectancy: Increased from 32 years in 1947 to 65 years in 2011, BUT we are nearly 15 years less than western countries.
2. New-born Mortality: Reduced to 37/1000 births in 2008, BUT still approximately 10 times more than western countries.
3. Child Mortality (0-5yrs): Reduced to 63/1000 in 2010 BUT still about 10 times more than western countries.
3.Almost 67% children are still not fully immunsed.
4. Maternal Mortality: Reduced to 254/lakh births in 2008 from 677/lakh births in 1980, BUT still almost 15-50 times more than western countries. (nearly 70,000 deaths per year)
5. Malnutrition In children under 5years: Reduced to 44% in 2006 from 67% in 1979, BUT still nearly 20 times more than western countries (Approximately 50% children under three are underweight)
6. Polio Eradicated almost completely: 1 new case recorded in 2011.
7. Leprosy: Eliminated in 32 States/UTs i.e. <1 1.27="" 2011-12.="" but="" case="" cases="" in="" lakh="" new="" p="" people="" reported="">8. Small Pox: Eradicated in 1977
9. Cholera: Reduced to 1939 new cases/year in 2006 from 2768 new cases/year in 1997. Sanitation and clean water are essential for total elimination

Building a Healthier Future Through School Health Programs

Despite the state of Uttar Pradesh having one of the worst health indices in the country, its dynamic Chief Minister, Akhilesh Yadav has been quick and far-sighted to realise that the key to setting things right in the long run may not lie in just building expensive hospitals, but supplementing it with creating health-consciousness in the minds of its young citizen so that they refrain from picking up risky habits and do not fall prey to preventable diseases.

In India, school is where several million young people spend around 6 hours of time each day for up to 13 years of their lives, providing a unique setting not just to impart scholastic education, but raise awareness on health issues that could impact their health and that of the nation.

In an unusually progressive step that matches what occurs in developed nations, Uttar Pradesh has become the first state to introduce health awareness as a component in its school curriculum. Based on the WHO concept of “school health promotion”, it has introduced a book called “ Hum Aur Hamara Swasthya” in its Madhyamik Shiksha curriculum, and is launching it in its basic education as well.

This book, written by a medical specialist and health expert and produced by a non-profit organisation called HOPE Initiative (Health Oriented Programs and Education), covers ten topics that that are considered universally important:

1. Sanitation and Hygiene that describes the seven steps of hand washing and covers toilet etiquette
2. Life style diseases such as excess consumption of fast food, lack of physical exercise, calculating one’s Body Mass Index, and tackling obesity in school children.
3. Managing examination stress
4. Bullying, ragging and violence in schools
5. Road Traffic accidents and their prevention
6. Global warming
7. Knowing about but resisting peer pressure initiation to alcohol, tobacco and drugs
8. Mosquito menace: simple steps to be taken at home and locality to ward off malaria and dengue
9. Hepatitis and its prevention. Ensuring vaccination from this preventable scourge
10. Celebrating festivals such as Diwali and Holi in a safe and healthy manner

The well-illustrated attractive book with pictures and cartoons aims to extend its reach beyond students to their siblings and parents, in what is described as a “school-to-community” approach. And to make the health topics interesting, HOPE has produced 6 documentary movies and 3 educational games as supplement.

The spade work for introducing health education in schools had begun few years ago with the Education Department of UP government engaging HOPE to provide training to teachers of 6000 schools of 25 districts of the state on health issues, with support from the philanthropic BMS Foundation.

Supporting school health programs to improve the health status of our nation’s young people has never been more important. Their health is critically related to the health-related behavior they choose to adopt.

Public health experts estimate that even a modest decline in the number of adolescents getting addicted to tobacco each year for instance, could lead to significant reduction in the incidence of heart and chest diseases, and save many lives from cardiac and cancer deaths in the community.